| NPI | 1407149404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME181625) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME181625) |
| 207Y00000X Otolaryngology (Licence: CT 75333) | |
| 207Y00000X Otolaryngology (Licence: IL 125059104) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME181625) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2026-06-30 |